Giovanna Ferrara

A comparison of three scales for measuring pain in children with cognitive impairment.

Pain is a neglected problem in children with cognitive impairments, and few studies compare the clinical use of specific pain scales. We compared the Non‐Communicating Childrens Pain Checklist Postoperative Version (NCCPC‐PV), the Echelle Douleur Enfant San Salvador (DESS) and the Childrens Hospital of Eastern Ontario Pain Scale (CHEOPS). The first two were developed for children with cognitive impairment, and the third is a more general pain scale.

Acquired long QT syndrome: a focus for the general pediatrician.

Abstract Acquired long QT syndrome (LQTS) is a disorder of cardiac repolarization most often due to specific drugs, hypokalemia, or hypomagnesemia that may precipitate torsade de pointes and cause sudden cardiac death. Common presentations of the LQTS are palpitations, presyncope, syncope, cardiac arrest, and seizures. An abnormal 12-lead electrocardiogram obtained while the patient is at rest is the key to diagnosis. The occurrence of drug-induced LQTS is unpredictable in any given individual, but a common observation is that most patients have at least 1 identifiable risk factor in addition to drug exposure. The cornerstone of the management of acquired LQTS includes the identification and discontinuation of any precipitating drug and the correction of metabolic abnormalities, such as hypokalemia or hypomagnesemia. Most of the episodes of torsade de pointes are short-lived and terminate spontaneously. We propose a management protocol that could be useful for the daily practice in the emergency pediatric department to reduce the risk of acquired QT prolongation.

Chronic nonbacterial osteomyelitis may be associated with renal disease and bisphosphonates are a good option for the majority of patients

The aim of this Italian study was to describe the clinical features, treatment options and outcomes of a cohort of patients with chronic nonbacterial osteomyelitis (CNO).

Application of Nonlinear Static Method with Corrective Eccentricities to Steel Multi-storey Braced Buildings

Nonlinear static methods may be not very effective in the assessment of 3D building structures because sometimes they do not provide an accurate estimate of the deck rotations. In order to overcome this shortcoming, the authors of this chapter proposed a nonlinear static approach for asymmetric structures that is performed applying the lateral force with two different eccentricities (named corrective eccentricities) with respect to the centre of mass of the deck. In this chapter the effectiveness of the corrective eccentricity method is verified with reference to four five-storey mass eccentric steel buildings in which the seismic force is sustained by frames equipped with buckling restrained braces.

Does Teno Torque Virus Induce Autoimmunity After Hematopoietic Stem Cell Transplantation? A Case Report.

Teno Torque virus, member of the family of Anelloviridae, has been associated with many autoimmune diseases such as idiopathic hepatitis, systemic lupus erythematosus, and multiple sclerosis. Its viral load tends to be higher in the bone marrow and in tissues with high turnover rate. We report here a case of an 11-month-old infant affected by acute myeloid leukemia who underwent hematopoietic stem cell transplantation, and after 6 months had autoimmune hepatitis and atopic dermatitis. Extremely high-cytokine IP-10 and eotaxin levels were found in her sera, and serological tests and RT-PCR for viruses showed positive results exclusively for Teno Torque virus.

Hematopoietic stem cell transplantation effects on spinal cord compression in Hurler

Hurler syndrome type 1 (MPS‐1) is an autosomal recessive lysosomal disorder due to the deficiency of the enzyme alpha‐L‐iduronidase which is necessary for the degradation of dermatan and heparan sulfate. It is characterized by deposit of glycosaminoglycans in tissues, progressive multisystem dysfunction, and early death. HSCT for children with MPS‐I is effective, resulting in increased life expectancy and improvement of clinical parameters. The spinal MRI performed on a female 10 yr old undergoing HSCT at the age of 18 months and receiving ERT revealed a considerable decrease in soft tissue around the tip of odontoid causing a significant reduction in spinal cord compression. In light of this result, we suppose that combined ERT and HSCT are successful in Hurler I disease.

Application of Nonlinear Static Method with Corrective Eccentricities to Multistorey Buildings: A Case Study

Nonlinear static methods are not always effective in the assessment of three-dimensional building structures because their estimate of the torsional response is not always reliable. To overcome this shortcoming, some of the authors have proposed a double application of the nonlinear static analysis by means of lateral forces applied to points of the deck characterised by different eccentricities with respect to the centre of mass. These eccentricities, named “corrective eccentricities”, were calibrated in such a way that the displacements of the edges of the deck evaluated by the two nonlinear static analyses equal those evaluated by nonlinear dynamic analysis. Analytical expressions of the corrective eccentricities were derived and presented in a previous study based on a parametrical investigation conducted on a wide set of one-storey systems subjected to bidirectional ground motions. In this chapter, the peculiarities of the application of the proposed nonlinear static method to multistorey buildings are discussed first. Second, as an example, the method is applied to predict the seismic response of a five-storey asymmetric building. The structure of the analysed building is constituted by reinforced concrete frames arranged along two orthogonal directions. The cross sections of the structural element are equal at all storeys. To test the effectiveness of the proposed method, the in-plan distributions of the deck displacement and drift are evaluated by nonlinear dynamic analysis and compared to those resulting from the nonlinear static method with corrective eccentricities. The obtained results show that the use of the corrective eccentricities leads to a suitable estimate of the maximum dynamic displacements and drifts.

Flares after withdrawal of biologic therapies in juvenile idiopathic arthritis: Clinical and laboratory correlates of remission duration

To assess the time in remission after discontinuing biologic therapy in patients with juvenile idiopathic arthritis (JIA).

Dealing with Chronic Non-Bacterial Osteomyelitis: a practical approach

BackgroundChronic Non-Bacterial Osteomyelitis (CNO) is an inflammatory disorder that primarily affects children. Although underestimated, its incidence is rare. For these reasons, no diagnostic and no therapeutic guidelines exist. The manuscript wants to give some suggestions on how to deal with these patients in the every-day clinical practice.Main bodyCNO is characterized by insidious onset of bone pain with local swelling. Systemic symptoms such as fever, skin involvement and arthritis may be sometimes present. Radiological findings are suggestive for osteomyelitis, in particular if multiple sites are involved. CNO predominantly affects metaphyses of long bones, but clavicle and mandible, even if rare localizations of the disease, are very consistent with CNO diagnosis. CNO pathogenesis is still unknown, but recent findings highlighted the crucial role of cytokines such as IL-1β and IL-10 in disease pathogenesis. Moreover, the presence of non-bacterial osteomyelitis among autoinflammatory syndromes suggests that CNO could be considered an autoinflammatory disease itself. Differential diagnosis includes infections, malignancies, benign bone tumors, metabolic disorders and other autoinflammatory disorders. Radiologic findings, either with Magnetic Resonance or with Computer Scan, may be very suggestive. For this reason in patients in good clinical conditions, with multifocal localization and very consistent radiological findings bone biopsy could be avoided. Non-Steroidal Anti-Inflammatory Drugs are the first-choice treatment. Corticosteroids, methotrexate, bisphosphonates, TNFα-inhibitors and IL-1 blockers have also been used with some benefit; but the choice of the second line treatment depends on bone lesions localizations, presence of systemic features and patients’ clinical conditions.ConclusionCNO may be difficult to identify and no consensus exist on diagnosis and treatment. Multifocal bone lesions with characteristic radiological findings are very suggestive of CNO. No data exist on best treatment option after Non-Steroidal Anti-Inflammatory Drugs failure.

A Precordial Rub in a Boy with a Severe Attack of Ulcerative Colitis

A case of a pneumomediastinum mimicking a pericarditis in a boy with an occult perforation due to ulcerative colitis is reported. Pneumomediastinum is a rare complication of severe attacks of ulcerative colitis, with or without the previous development of a toxic megacolon, that should be considered in the differential diagnosis.